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VIDEO: Dr. Rachel Leonard talks about Behavioral Activation

Rachel Leonard, PhDdiscusses what behavioral activation is and how it is used in treating depression

Featured Doctor: Rachel Leonard, PhD, clinical supervisor, FOCUS

Leonard: The idea behind behavioral activation is that something might set off someone's depressive episode. It could be a really big, identifiable event like a job loss or it could be small changes in somebody's life over time, and when those types of things happen people experience a lot of different negative emotions. In response to those negative emotions people have a natural tendency, which makes perfect sense, to avoid and retreat, to try not to put themselves out there where they feel vulnerable. It's keeping people from living their lives and having positive experiences as well and so that can create a cycle of depression. The more they avoid and retreat, the more negative things happen to them.

Behavioral activation looks at specific ways that people might be avoiding different things in their lives and how that avoidance can make their depression worse and then works to strategically identify activities that can help them to gradually feel less depressed and more engaged in their lives. One is routine activities, so this is looking at one's activities of daily living. When people get depressed they might not be showering as often, changing their clothes, making their bed or paying their bills.

A second area or target is enjoyable activities. So things that they used to enjoy that maybe aren't doing because of their depression. Possibly things that they would have wanted to try but have never tried, so looking to gradually increase activities that might bring a sense of enjoyment to them.

A third area that some versions of behavioral activation incorporate is looking at values. So what is meaningful to that patient and it could be something really leaning towards mastery type of tasks, so obtaining a job, going back to school, getting a report done, something more skill-based. Or it could be something more interpersonal, so if they value being a good mother it could involve setting up strategic assignments to work on with their child.

CBT is a broad umbrella for a lot of different therapy approaches, and the idea is that one's behaviors, thoughts and feelings are all interrelated and when people come into treatment they're looking to change how they feel, but through therapy there really isn't a direct way to change one's feelings. With behavioral activation, what we're looking to do is change their behavior in very strategic ways which has been found to change their thinking patterns and both of those things can work together to enhance their mood.


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